CMS/EIP Fiscal Report Center: 53
Services beginning 07/01/2023 ending 09/30/2023 Date of Report:10/10/2023 Page: 1
List order: No List
Agency Filter:EXT
Payclass Filters:TPIN
Eligibility Filter:Part C (excluding not eligible)
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Screening, Eval, and Assessment,Class #02
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 1 1.000000 14.6800 14.6800
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 1 2.000000 150.0000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 1 2.000000 150.0000 75.0000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 4 6.500000 487.5000 75.0000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 2 3.500000 194.2500 55.5000
Subtotal (Total Children Is Unduplicated) 9 15.000000 996.4300 66.4287
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EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 31 145.000000 7250.0000 50.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 11 30.000000 1500.0000 50.0000
EPIC-99601-Early Steps Professional Development Fee 6 11.000000 165.0000 15.0000
OCCT-97530-OT SESSION BY LICENSED OT 13 57.000000 4101.7200 71.9600
OCCT-97530GT-OT SESSION BY LICENSED OT 2 2.000000 143.9200 71.9600
Subtotal (Total Children Is Unduplicated) 49 245.000000 13160.6400 53.7169
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Total 260.000000 14157.0700 54.4503
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Number of Children (Unduplicated) With at Least One Service 57
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Center 53
Flag Claims Units Chgs Paid
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R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 0 0.000000 0.0000 0.0000
P 0 0.000000 0.0000 0.0000
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 124 124.500000 5864.1400 5864.1400
130 135.500000 8292.9300 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 254 260.000000 14157.0700 5864.1400